Individual
JESSICA D FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 358-2078
Mailing address
7703 FLOYD CURL DR, SAN ANTONIO, TX 78229-3901
(210) 358-2078
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10849
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
365229901
—
TX
01
—
365229902
CSHCN
TX
Enumeration date
09/21/2016
Last updated
09/16/2024
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